Isolating Tuberculosis: Sanatoria and the Mortality Transition in Large European Cities

Nina Boberg-Fazlic, Casper Worm Hansen and Peter Sandholdt Jensen

No 22074, CEPR Discussion Papers from Centre for Economic Policy Research

Abstract: Tuberculosis (TB) mortality declined sharply in Europe before effective drug therapies became available, but the contribution of public health interventions remains disputed. This paper estimates the effect of TB sanatoria on mortality in 94 major European cities between 1880 and 1909. We combine newly digitized information on the opening dates and locations of 442 sanatoria with annual cause-specific mortality data and exploit variation in the timing of first sanatorium openings in a staggered difference-in-differences design. The opening of the first sanatorium within 100 km reduced TB mortality by 24-39 deaths per 100,000 inhabitants, equivalent to approximately 10-15 percent of the sample mean. The estimated reduction increases with time since opening, reaching approximately 45 deaths per 100,000 after ten years. Evidence from the German Empire shows mortality reductions for sanatoria serving adults with pulmonary TB, but no clear evidence of reductions for children's institutions. We find no evidence of reduced TB mortality in the predominantly rural districts of Württemberg. These findings are consistent with sanatoria contributing to the mortality transition by isolating infectious adults from densely populated urban environments.

Keywords: Mortality transition; Infectious disease; Public health; Isolation (search for similar items in EconPapers)
JEL-codes: I15 J18 N34 (search for similar items in EconPapers)
Date: 2026-10
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